Provider Demographics
NPI:1780012476
Name:OCTAIN, SHAGUNDEEP (DDS)
Entity type:Individual
Prefix:DR
First Name:SHAGUNDEEP
Middle Name:
Last Name:OCTAIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21660 BARRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-1140
Mailing Address - Country:US
Mailing Address - Phone:734-707-8684
Mailing Address - Fax:
Practice Address - Street 1:1037 MADISON AVE N
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1727
Practice Address - Country:US
Practice Address - Phone:206-842-9890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856315122300000X
MI2901021055122300000X
WADE61157994122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist